Individual
JENNIFER L MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CST
Contact information
Practice address
2600 FERRY ST, LAFAYETTE, IN 47904-3055
(765) 448-8000
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
CERT # 122776
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000680624
ANTHEM PROVIDER NUMBER
IN
Enumeration date
09/24/2010
Last updated
10/22/2010
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